Types of antidepressants

Certain brain chemicals called neurotransmitters are

associated with depression — particularly serotonin (ser-o-

TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine

(DOE-puh-meen). Most antidepressants relieve depression by

affecting these neurotransmitters. Each type (class) of

antidepressant affects these neurotransmitters in slightly

different ways.

Many types of antidepressant medications are available to

treat depression, including:

Selective serotonin reuptake inhibitors (SSRIs). Doctors

often start by prescribing an SSRI. These medications

generally cause fewer bothersome side effects and are

less likely to cause problems at higher therapeutic doses

than other types of antidepressants are. SSRIs include

fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline

(Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

Serotonin and norepinephrine reuptake inhibitors

(SNRIs). Examples of SNRI medications include

duloxetine (Cymbalta), venlafaxine (Effexor XR),

desvenlafaxine (Pristiq, Khedezla) and levomilnacipran

(Fetzima).

Atypical antidepressants. These medications don't fit

neatly into any of the other antidepressant categories.

They include trazodone, mirtazapine (Remeron),

vortioxetine (Trintellix), vilazodone (Viibryd) and

bupropion (Wellbutrin, Aplenzin, Forfivo XL). Bupropion is

one of the few antidepressants not frequently associated

with sexual side effects.

Tricyclic antidepressants. Tricyclic antidepressants —

such as imipramine (Tofranil), nortriptyline (Pamelor),

amitriptyline, doxepin and desipramine (Norpramin) —

tend to cause more side effects than newer

antidepressants. So tricyclic antidepressants generally

aren't prescribed unless you've tried other

antidepressants first without improvement.

Monoamine oxidase inhibitors (MAOIs). MAOIs — such

as tranylcypromine (Parnate), phenelzine (Nardil) and

isocarboxazid (Marplan) — may be prescribed, often

when other medications haven't worked, because they

can have serious side effects. Using an MAOI requires a

strict diet because of dangerous (or even deadly)

interactions with foods — such as certain cheeses,

pickles and wines — and some medications, including

birth control pills, decongestants and certain herbal

supplements. Selegiline (Emsam), an MAOI that you stick

on your skin as a patch, may cause fewer side effects

than other MAOIs. These medications can't be combined

with SSRIs.

Other medications. Your doctor may recommend

combining two antidepressants, or other medications

may be added to an antidepressant to enhance

antidepressant effects.